Alfredo Cortes Email and Phone Number
florida, united states
Alfredo Cortes's Location
Miami-Fort Lauderdale Area, United States
About Alfredo Cortes
Over thirty years of extensive knowledge of health care/Managed Care industry trends and demographics; ability to formulate/implement strategies, achieve, exceed target impact, and meet financial goals. Emphasis in Managed Care Contracting and experienced with all lines of business, Medicare, Medicaid, and Commercial. Network Development/Expansion and Operations, focusing on contracting/negotiating large hospital/health systems, physicians and ancillary providers. Working knowledge of various contracting methodologies. Knowledge of new healthcare trends, Accountable Care Act, Medical Homes, ACO’s and Health Care Reform. Payer and Provider experience as well as Physical, Behavioral health and Dental provider contracting experience.Experienced with all major national geographic markets, West, Midwest, Northeast, Southwest, and Southeast in Metropolitan as well as Rural areas.
Alfredo Cortes's Current Company Details
Cisne Health
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Senior Managed Care Consulting Executive
florida, united states
- Website:
- cisnehealth.com
- Employees:
- 2
Alfredo Cortes Work Experience Details
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Senior Managed Care Consulting ExecutiveManaged Care Consulting Mar 2012 - PresentUnited StatesProvider Network Development/Expansion, payer/ provider, hospital contracting/negotiations, physical, behavioral health, dental, vision as well as ancillary provider contracting experience on a national scope. Contract Negotiations/Re-negotiations.
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AdvisorCisne Health Jul 2021 - PresentUs NationalCisne Health is a Value-Based Care Management Company offering primary care physicians the tools for optimizing their Medicare revenue at no cost and total physician choice of the level of financial risk and reward (including no risk). We support primary care physicians through:Negotiating better payment for your Medicare patient populationCoding and billing management for your Medicare Advantage patientsCare coordination and related documentation supportMarketing your Medicare Advantage plans to your Medicare patients during the annual Medicare open enrollment periodAs a primary care physician in independent practice, you can increase your revenue without seeing more patients while maintaining your independence and control of the way you practice.Visit us at: https://providers.cisnehealth.com/
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Advisor/ConsultantAlphasights Jan 2020 - PresentNationalAdvisor/Consultant -
Advisor/ConsultantGuidepoint Jan 2021 - PresentUnited StatesHealthcare advisor -
Market Engagement Director (Consultant)Clear Spring Health Aug 2022 - Oct 2024Florida, United StatesProvider Network Development, Large Group,Hospital Contracting. -
ConsultantAllied Mobile X-Ray & Ultrasound 2017 - Jul 2022FloridaNegotiate/Renegotiate Existing Payer Contracts and Payer Service Areas Expansion , Acquire New Payer Contracts, Revenue Cycle Management/AR Collections.
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Sr. ConsultantEwings Inc. Nov 2021 - Jun 2022Florida, United StatesProvider Network Development/Expansion, Contract Negotiations. Provider Network Expansion build for Partners Direct Health. -
ConsultantEssential Healthcare Solutions, Llc Aug 2019 - Nov 2021NationalProvider Network Development, Expansion/contracting in conjunction with Comprehensive Health Services a Caliburn Company for the Veterans Affairs Disability Examinations Management (VA DEM) contract for 2021. Anthem/WellPoint Military Reserve Health Readiness Program III. -
ConsultantAndros Jul 2019 - Nov 2020NationalNetwork Development/expansion/contracting engagements for client projects for Liberty Dental Plan, Cigna/Health Spring 2021 Medicare Advantage Plan, Versant Health, Alignment Healthcare. -
ConsultantTriwest Healthcare Alliance Nov 2018 - Apr 2019NationalNetwork development/expansion for TriWest Healthcare Alliance/VA Patient-Centered Community Care (PC3) Veterans Choice Program (http://www.triwest.com/) in multiple states in conjunction with ARC Health and Essential Health Care Solutions -
ConsultantNational Aco, Llc Jan 2015 - Nov 2015California, Pennsylvania, Tennessee, FloridaInterfaces and builds relationships with leaders in the medical community. Negotiates, evaluates anddevelops network development opportunities. Participates in cross-department teams to analyzebusiness opportunities and address critical issues (e.g. network growth, provider termination, etc.)Collaborates with NACO leadership on network development, network financial, quality and physicianperformance and engagement opportunities.development of networks including IPAs, physician groups, and other organizations which will enhance NACO’s shared savings distribution and adding value to participating NACO physicians. Expansion markets; overall performance of physician networks, and strategic planning. -
ConsultantMagellan Health Nov 2013 - Oct 2014FloridaImplemented development activities for a broad range of Providers to include- Ancillary Providers, Hospitals, and Outpatient Providers. Oversaw the provider credentialing process, managed account service managers. Negotiated contracts, developed strategies and methodologies, for specific initiatives and geographic regions.• Served as the entry point/system of checks and balances between Network development and other Corporate/Plan departments (for the purpose of reviewing significant Provider contracts for all plans) -
ConsultantConsolidated Health Care Services / A1 Imaging Centers, Llc Jan 2013 - Sep 2013Florida, TexasNegotiated/renegotiated contracts with managed care payers, and other payer entities. Negotiated appropriate fee schedule rate of pay. Oversaw the credentialing of clinicians/facility, enrollment of providers with payers, and ensured all credentialing guidelines were met within a timely manner. Created strong provider education and compliance review nationwide. •Ensured that the payer adhered to contractual agreement •Educated Provider/Employees on payer rules • Supervised Credentialing Staff ensuring that all deadlines were met and applications were correct •Oversaw extensive AHCA Medicaid application and ensured completion accuracy •Supervised compliance Specialists • “Championed” Independent Diagnostic Testing Facility Managed Care business model across all levels
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ConsultantConcordia Behavioral Health Feb 2012 - Dec 2012FloridaImplemented development activities for a broad range of Providers to include- Ancillary Providers, Hospitals, and Outpatient Providers. Oversaw the provider credentialing process. Negotiated contracts, developed strategies and methodologies, for specific initiatives and geographic regions.•Effectively worked with providers to implement cost saving initiatives •Recruited/Contracted with physicians, physician groups, hospitals and outpatient facilities•Assessed, developed, recruited, organized provider for all applicable networks •Negotiated complex contractual agreements with Physician, Ancillary, and Hospital Providers • Acted in an advisory capacity to the Legal Department with regard to the financial and legal impact of Provider Contractual language -
Senior Vice President Of Operations And Provider RelationsMedlink Aug 2004 - Feb 2012Us And InternationalDeveloped comprehensive provider networks in Florida, Bahamas, Costa Rica, Brazil and the Dominican Republic consisting of: Hospitals, Primary Care physicians, specialists and Ancillary Providers.
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Vice President Of Operations And Network DevelopmentEhdl (Health Net Data Link) Apr 2002 - Jul 2004Florida, Georgia
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Executive DirectorCommunity Health Purchasing Alliance (Chpa District 11) Jan 1998 - Jan 2002South FloridaOrganized and developed CHPA operations in accordance with the mission and Policies of the Board of Directors. Recruited, trained, and motivated licensed insurance agents to market CHPA products.•Created public awareness of CHPA products/services •Promoted Network Sales.• Represented small business insurance interests, assisted them as a group in obtaining affordable health insurance.
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Director Of Customer Service And RetentionPhysician Corporation Of America (Pca) Jul 1995 - Nov 1997Miami, Florida
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Supervisor Account Service DepartmentPhysician Corporation Of America (Pca) May 1994 - Jul 1995Miami, Florida
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National Account ExecutivePhysician Corporation Of America (Pca) Mar 1990 - May 1994Miami, Florida
Alfredo Cortes Education Details
Frequently Asked Questions about Alfredo Cortes
What company does Alfredo Cortes work for?
Alfredo Cortes works for Cisne Health
What is Alfredo Cortes's role at the current company?
Alfredo Cortes's current role is Senior Managed Care Consulting Executive.
What schools did Alfredo Cortes attend?
Alfredo Cortes attended Mercer University.
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Alfredo Cortes
Somerset, Nj4rcainc.com, hotmail.com, sgs.com, rcainc.com1 +41 22 XXXXXXXXX
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Alfredo Ramirez-Cortes
Simplicity Group | Canyon Angels | Grand Canyon University | Passionate About Driving GrowthPhoenix, Az -
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